What's in the well? Pediatrician probes ACEs and the biology and roots of toxic childhood stress

Boot-strapping types who believe that surmounting a difficult childhood is mainly a matter of will may be perplexed by an anecdote near the beginning of Nadine Burke Harris's new book, "The Deepest Well: Healing the Long-Term Effects of Childhood Adversity."

In it, the pediatrician describes a 7-year-old boy named Diego, who showed up at her Bay Area clinic looking like an undersized 4-year old. He had been referred by a school nurse for suspected ADHD. But Burke Harris also noted that her young patient had patchy skin and a chronic wheeze. A few probing questions of his mother unleashed a torrent of information. Most significantly, Diego had been sexually abused by a family friend when he was, yes, 4 years old. He hadn't grown since.

In her book, Burke Harris boils down two decades of research showing the ways that early trauma – what she calls toxic stress – can trigger hormonal changes that manifest in serious physical symptoms.

The root need not be anything as severe as sexual abuse. Day after day, she writes, infants with strange rashes, or kindergartners whose hair was falling out, showed up at her clinic – not to mention patients demonstrating epidemic levels of learning and behavioral problems. The phrase statistical significance kept echoing through her mind.

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In fact, the linkage between early trauma and later health outcomes had been known since 1998, when two doctors with the federal Centers for Disease Control outlined the profound health effects of adverse childhood experiences – known as ACEs – in 17,000 adult patients, most of them white and college-educated. Burke Harris' contribution puts a pediatrician's lens on the research and, by extension, its implication for schools.

For instance, in ADHD diagnoses.

"What if the cause of these symptoms – the poor impulse control, inability to focus, difficulty sitting still – was not a mental disorder, exactly, but a biological process that worked on the brain to disrupt normal functioning?" she writes.

While many of her young patients came from homes rife with violence and neglect, experiences as common as divorce or maternal depression can flood a child's system with so much stress hormone that it affects their blood pressure, blood sugar, and neurology, Burke Harris notes.

During a talk recently at Seattle's Town Hall, she poked holes in the belief that such impacts show up only in cases of extreme deprivation, and that middle-class households are immune. Two-thirds of U.S. adults have at least one ACE, she noted, and 12.6 percent have four or more, making them twice as likely to develop heart disease or cancer.

"This is us," she said. "This is all of us."

A public health researcher at Washington State University has already correlated the effect that ACEs can have on learning and behavior problems, and a handful of schools around Washington are taking action, teaching kids to understand the ways their brains process experience.

Given the dire stakes, Burke Harris's prescription sounds relatively anodyne: sleep, exercise, nutrition, meditation, mental health counseling and healthy relationships. But it, too, is grounded in research. She suggests screening all children for ACEs before they enter school, as with vaccinations, in hopes of catching risk factors before they become medical or behavioral problems.

But in some communities that recommendation has encountered swift, impassioned resistance.

During a discussion at the Crosscut Festival, James Banks, a distinguished professor of multicultural studies at the University of Washington, vigorously opposed saddling kids with an ACE score. Medical testing has a troubled history among African-Americans and kids hardly need another label, he said.

During the same discussion, Lyon Terry, a fourth-grade teacher at Lawton Elementary, wondered aloud if knowing his students' difficult pasts might unconsciously undermine his expectations for them.

Burke Harris has weathered similar questions. Her answer, unsurprising for a scientist, focuses on the benefits of having more knowledge, rather than less.

"We are missing this massive opportunity for folks to begin to recognize not only how it's affecting themselves and their loved ones," she said at Town Hall, "but the fact that we are all drinking from the same well."